Clinical profile, treatment patterns, and early outcomes of colorectal cancer at Kassala Police Hospital, Eastern Sudan: a 10-year retrospective cohort study

In low-resource settings with limited access to multimodal care, colorectal cancer is characterized by delayed diagnosis and a high incidence of emergency presentation. Robust contemporary longitudinal data from Eastern Sudan are scarce. This is a retrospective cohort study recruiting all patients who underwent colonic or rectal resection for colorectal cancer between June 2013 and June 2023. Extracted data included demographic, clinical, operative, oncologic, and outcome variables. Fisher’s exact tests, χ² tests, t-tests and ANOVA were used for bivariate analysis. Independent predictors of outcomes were identified using multivariable logistic and linear regression models. Kaplan–Meier methods and Cox proportional hazards models were used to analyze time-to-event outcomes, with competing-risk analysis applied for recurrence. The study included 604 patients (59.4% male), with a mean age of 53.5 years. Most patients (495/604, 82.0%) had stage II disease, emergency cases were 25.8% (156/604), while 63.2% of cases were rectal and left-sided cancers. A statistically significant association was identified between emergency surgery and advanced stage, higher morbidity, anastomotic leak, intensive care unit admission, mortality, and recurrence (p < 0.001). Multivariable analysis revealed that independent predictors of mortality included advanced stage, emergency operation, advanced age, postoperative morbidity, and intensive care unit admission. Predictors of recurrence included advanced stage and left-sided/rectal tumor location. Hospital stay was significantly prolonged by postoperative morbidity and stoma formation. The highest recurrence rate (26.3%) occurred with rectal cancers, with underutilization of neoadjuvant and radiotherapy. In Eastern Sudan, a significant portion of colorectal cancer presents as an emergency at an advanced stage, associated with high rates of morbidity, recurrence and mortality. While rectal tumors were disadvantaged by limited access to multimodal therapy, right-sided tumor location was protective. For survival and other outcomes, there is an urgent need for earlier detection and increased accessibility to chemoradiotherapy.